MEDICARE: DR. JOSIE GEMARIE DE LEON OLIVA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019.027925	IL
2	1223G0001X	General Practice Dentistry	D010137	AZ

General Provider Information

NPI Number	:	1134357577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSIE GEMARIE DE LEON OLIVA DDS

Provider Business Mailing Address
First Line	:	4143 E DEVON DR
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-1411
Country	:	US
Telephone Number	:	224-610-9823
Fax Number	:

Provider Business Practice Location Address
First Line	:	3125 W HUNT HWY STE 101
Second Line	:
City	:	SAN TAN VALLEY
State	:	AZ
Zip	:	85142-9331
Country	:	US
Telephone Number	:	480-900-6622
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2009
Last Update Date	:	04/15/2019

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